MEDICARE: DR. MINAJ NAIMI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21216	MA
2	1223G0001X	General Practice Dentistry	46652	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V06115	OTHER	MA	BLUE SHIELD

General Provider Information

NPI Number	:	1053465542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINAJ NAIMI DDS

Provider Business Mailing Address
First Line	:	5450 THORNWOOD DR STE B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1222
Country	:	US
Telephone Number	:	408-360-0270
Fax Number	:	408-360-0275

Provider Business Practice Location Address
First Line	:	5450 THORNWOOD DR STE B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1222
Country	:	US
Telephone Number	:	408-360-0270
Fax Number	:	408-360-0275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	01/21/2021

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